info@slncda.org
Become a member

The Burden in Sierra Leone

Every figure below comes from a published study conducted in this country.

45.7%

hypertension prevalence among adults aged 35 and over in the KrooBay informal settlement, Freetown.

BMC Public Health, 2024
81.5%

of adults in that same community were physically inactive, and 99% did not eat enough fruit or vegetables.

WHO STEPS survey, 2019
500

new cervical cancer cases every year, with an estimated 400 deaths. It is the leading cancer killer of women aged 14 to 44.

National Cancer Registry
Zero

national newborn screening programmes for sickle cell disease, in a country carrying one of the highest burdens in the world.

PLOS One, 2026

The treatment gap, measured

A 2018 household survey of 1,892 adults aged 40 and over in Bo district applied the WHO and International Society of Hypertension risk calculator, then checked who was actually receiving the treatment they needed.

Who needs treatment, and who gets it

Bo district, adults aged 40 and over. Percentages are weighted.

Share of the population who need treatment Share of those people who are receiving it
Hypertension 48.4% 13.3% Any risk factor (treat to target) 52.3% 19.3% Any risk factor (WHO PEN guidelines) 20.6% 15.8% Diabetes 3.3% 18.3% Raised cholesterol 6.9% 0%

What the health system is ready to deliver

Facility readiness scores across all 138 health facilities in Bo district, WHO SARA 2017.

Cardiovascular disease and its risk factors HIV, shown for comparison
Overall readiness 16.8% 41% Basic equipment 67% 80.2% Diagnostic capacity 10.9% 18.6% Trained staff 2.2% 41.3% Medicines in stock 5.9% 45% Clinical guidelines 0% 19.9%

What this means for Sierra Leone

  • The need is large and almost entirely unmet. Nearly half of adults over 40 in Bo met the criteria for hypertension treatment. Around one in eight of them was receiving it. Not one person who needed a statin was on one.
  • This is a funding decision, not a capability problem. The same facilities score 41% ready for HIV care and 17% for cardiovascular care. HIV services in Sierra Leone received roughly 30 million dollars in 2017. All non-communicable disease care received 510,000 dollars. What sustained investment can build is visible in the same buildings.
  • Guidelines cost almost nothing and are entirely absent. No facility in Bo district held guidelines for diagnosing or managing cardiovascular risk. That is the cheapest gap on either chart to close.
  • The economic argument is about working-age adults. These conditions strike people who are earning and supporting households. Care arrives late, is paid for out of pocket, and the household absorbs both the treatment cost and the lost income. Prevention at primary care level is far cheaper than the stroke ward.

Source: Odland ML, Gassama K, Bockarie T, Wurie H, Ansumana R, Witham MD, Oyebode O, Hirschhorn LR, Davies JI. Cardiovascular disease risk profile and management among people 40 years of age and above in Bo, Sierra Leone. PLOS One 2022;17(9):e0274242. Funded by the Wellcome Trust. Read the paper